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Can social media have a role in tackling vaccine hesitancy?

The World Health Organization's European Immunization Week has just come to a close, having celebrated and raised awareness of the benefits of vaccines. But despite overwhelming evidence of these benefits, vaccine hesitancy remains a huge problem – more so in Europe than anywhere else. How can we combat the spread of misinformation?

Europe is the most vaccine-hesitant region in the world, and we are now witnessing the results.

Vaccine hesitancy is not new, but today – as the use of social media continues to increase – opportunities to spread misinformation and pseudoscience are unprecedented. Facebook, Twitter and other networks are taking steps to limit anti-vax content – but is it enough? And is there a role to harness social media for the powers of good?

The fatal impact of vaccine hesitancy

The news in recent months has made for depressing reading. Measles outbreaks in the US and Europe are growing. In 2018, there were over 82,000 cases of measles confirmed in the EU – three times more than in 2017 – and measles led to 72 deaths. Cases of measles are affecting all unvaccinated groups, adults and children alike, with large numbers of cases and fatalities in countries which had previously eliminated the disease.

Vaccine hesitancy is a key reason for this worrying trend. Europe is the most vaccine-hesitant region in the world, and we are now witnessing the results. Last year’s wide-ranging survey of vaccine confidence in Europe, led by Heidi Larson and her colleagues from the Vaccine Confidence Project, found that the picture in the EU is complex with varying levels of vaccine confidence between countries. Alarmingly, they found that in some countries, including the Czech Republic and Slovakia, at least a quarter of GPs did not agree that the MMR vaccine was safe. Furthermore, low confidence among GPs is correlated with low confidence among the general public.

Of course, in most countries, the vast majority of the population receive all – or at least most – of the vaccines recommended for them. Problems arise, however, when a small minority choose to refuse or delay vaccination, bringing the community’s levels below the threshold needed for herd immunity and leaving them open to an outbreak.

Problems arise when a small minority choose to refuse or delay vaccination, bringing the community's levels below the threshold needed for herd immunity and leaving them open to an outbreak.

The role of social media

At the core of social media is the ability for us to share ideas and content with our peers. While this freedom of information is what makes social media so appealing, it is also what can make it dangerous. Social media is not the cause of vaccine hesitancy, but it has certainly played a role in making anti-vaccination arguments and pseudoscience accessible to a wider audience.

Recent announcements from Facebook, Instagram and YouTube, among others, point to change. Facebook is down-ranking anti-vax content in its search results and rejecting anti-vax adverts. Instagram will not show or recommend content with misinformation about vaccinations, while YouTube has removed adverts from channels which promote anti-vax content.

These changes are encouraging, but are they enough? None of these sites are removing the harmful content, just making it more difficult to find. Furthermore, given that there seems to be some correlation between political populism and vaccine refusal, at least in some countries, might the changes implemented by social media companies play into the hands of the most vocal anti-vaxxers, providing them with the opportunity to point to censorship of their freedom of speech and to deepen their mistrust of the mainstream?

Enough of the problems – what about solutions?

The first point to make is that those who are considered vaccine hesitant are not a homogenous group and their views are not necessarily fixed. While some could be considered refusers, others may be less certain and have decided to delay vaccination. Recent research from Australia found that vaccine-hesitant parents could be categorised as ‘fixed-view’ or ‘susceptible’. Willingness to vaccinate (both positive and negative) was more likely to change among those who were reported as susceptible.

These findings have a number of implications:

The impact that negative vaccination messages can have on people who do not yet have fixed views: limiting access to these messages – through, for example, stricter social media – could therefore hold some promise for this group. But, as noted, this is not without its challenges.

The potential for a more positive approach: sharing pro-vaccine messages through social media and other channels could be important in supporting those who do not have fixed views to make positive vaccination decisions.

The limitations of fighting firmly held views with new data: blinding people who have fixed anti-vaccination views with science and data from official sources is not likely to be ineffective. They are unlikely to change their minds.

Additionally, it is worth understanding that while much attention has rightly been paid to vaccine-hesitant parents to try and improve measles vaccination rates among children, unvaccinated adults are also at risk of catching measles and spreading it to others. In fact, measles is likely to lead to more serious complications among adults than children. While adults born before the 1960s or 1970s may have natural immunity, those born later may not. These people may not, however, recognise the importance of vaccinating themselves, seeing it as more of an issue for children.

Together, this suggests that the group that we, as pro-vaccine advocates, should focus our efforts on are those who are open to hearing these messages, and those who would consider vaccination for themselves or their children. People who are interested in the debate and are, as yet, undecided. It is encouraging to see a public groundswell among the scientific community, one which aims to rival the vocal anti-vaxxers, but evidence-based messaging is unlikely to be successful on its own.

We must all play our part. People are more likely to respond to vaccine messaging (pro or anti) when it comes from within their community. By harnessing the power of social media, we can share information and evidence but also our experiences and thoughts with the vaccine hesitant among our peers. We must all take responsibility to spread the word on the importance of vaccination and turn the tide against misinformation.

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